How safe is home birth? What you should know

March 15, 2016 Providence Health Team

How you create your birth plan is a deeply personal decision. Who do you want to be present? Will you have a natural childbirth? Will you give birth at a hospital or someplace else?

Out-of-hospital births, defined as taking place anywhere except a hospital, such as a home or birthing center, have been on the rise since 2004. However, according to data collected by the Centers for Disease Control and Prevention, the number of births that occurred out of a hospital was less than 1.4 percent of all U.S. births in 2012.

Why such a low percentage of out-of-hospital births? For more than half a century women have given birth in hospitals because it was believed to be the safest place for delivery. A birth that occurred outside a medical setting was considered risky and frowned upon by medical professionals.

New study examines risks of home births

The perception that a hospital is the only safe place to give birth is changing. Now there’s a new study from the New England Journal of Medicine that shines some light on the actual risks of giving birth at home.

A team of health professionals reviewed 80,000 pregnancies in Oregon during 2012 and 2013 and here’s what they learned about out-of-hospital births, compared with hospital births:

  • A baby is 2.4 times more likely to die during birth or within the first month of life, compared with a baby born in a planned hospital delivery.
  • A woman is less likely to require a C-section (5.3 percent compared with 24.7 percent in the hospital).
  • A baby is more likely to have a neonatal seizure or need a ventilator.
  • A woman is more likely to need a blood transfusion.
  • A woman is less likely to have induced labor or lacerations.

Severe complications, including death, were rare regardless of location. Even though early death is more likely to occur outside a hospital, the total number of deaths is relatively low: 3.9 out of 1,000 for out-of-hospital births compared with 1.8 out of 1,000 for a planned hospital delivery. 

The study was made possible, in part, by a recent change to Oregon birth certificates requiring a woman to list not only where she gave birth, but also where she planned to deliver. The researchers adjusted for women’s race, age and pregnancy risks, so those factors could explain any delivery problems.

Is home birth right for you?

“The study showed that home birth is safe for women when there’s been careful consideration of risk factors,” says Providence Health & Services midwife Lizzie Herskovitz, CNM, ARNP, MSN, in Everett, Wash. Home birth is not recommended for women who have pregnancy complications such as high blood pressure, a breech baby or multiples.

Home birth may be right for you “if you want to have the experience of labor without medical interventions and privacy is very important for you. Then it can be a transformative experience,” she says. “But if you’re the type who might want pain medicine in labor, or worries about birth complications, you should consider a hospital birth where you can be monitored medically.”

If you are considering a home birth, ask yourself these questions:

  • Are you committed to having a natural birth (without epidural, nitrous oxide or I.V.)?
  • Are you willing to have a midwife deliver your baby?
  • Is your house logistically set up for a home birth? (Do you have roommates? Are you in the process of moving?)
  • Are you prepared to stock up on food and other supplies for you, your partner and health care providers for at least 24 hours?
  • Are you ready to educate yourself and put together a home birth plan?

How do you choose a midwife?

All Providence midwives are certified nurse-midwives (CNM), which means they have the highest level of education and training. CNMs are registered nurses with a master’s or doctoral degree in science or nursing. (Some states license other types of midwives, but CNMs can practice in any state.) 

“You want someone who is experienced,” says Herskovitz. “You will see this person for all your visits. Does she feel trustworthy and open?”

Consider these factors when finding the best midwife for you:

  • Ask about education and experience.
  • Ask about an intense case or emergency situation and how the midwife responded. 
  • Ask about a transfer hospital. Should something happen, do you have a clear transfer plan in place?
  • Do you have a good rapport with the midwife?
  • If you want a home birth but cannot have one for whatever reason, ask your midwife what the hospital can accommodate.

If you need a provider for your pregnancy, find one near you.

Previous Article
Advance directives: Everyone needs one
Advance directives: Everyone needs one

Do you have an advance directive? Read about how an advance directive gave one woman peace of mind.

Next Article
Child life specialists make hospitals less scary
Child life specialists make hospitals less scary

Two stories illustrate the different ways that child life specialists help relieve anxiety and create posit...